Since the US has begun publishing data regarding the financial relationships between healthcare professionals and the pharmaceutical industry as required by the Sunshine Act in 2014, the Canadian government, both at federal and provincial levels, has begun contemplating the implementation of a similar system. 

Why transparency?

The push for transparency in Canada stems from two main concerns: the privileged relationship between the pharmaceutical industry and healthcare professionals at the federal level, and the amounts that healthcare professionals bill to the Ontario Health Insurance Plan (OHIP) on the provincial level.

The US Sunshine Act aims at addressing the first of these two issues by requiring pharmaceutical companies to track the amount of all transfers of value they make to individual healthcare professionals.  These amounts are then disclosed and made publicly available on a government website.  It is thus possible to deduce and track potential conflicts of interest or changes in prescribing habits.  Physicians are required to make the best unbiased medical decisions for their patients, and the US Sunshine Act is seen as a tool to boost the public’s confidence when soliciting the services of a healthcare professional.

No such disclosure exists in Canada for the moment.  However, ten prominent pharmaceutical companies: GlaxoSmithKline, AbbVie, Amgen, Bristol-Meyers Squibb, Gilead, Eli Lilly, Merck, Novartis, Purdue and Roche, have taken the initiative to take part in a voluntary disclosure in 2017.

This first step to ensuring transparency will be made on the aggregate level: it will not include the names and amounts paid to individual physicians, but it will provide a global amount as to how much pharmaceutical companies are investing in their relationships with healthcare professionals.

This voluntary disclosure has been met with both acclaim and criticism from the public.  Many see it as a necessary step in ensuring the safety and best interests of the public, while some criticize the aggregate nature of the disclosure, believing that it does not provide enough transparency to allow for informed decisions, and is simply an “Americanization” of Canadian society.

The second transparency related issue deals with the amounts billed by Ontario doctors to OHIP.  This issue has arisen as public funds are in short supply and the demand to access them is steadily increasing.

Each year, the province of Ontario discloses the salaries of all public employees earning more than $100 000 on the Sunshine list.  Doctors pay has always been excluded from this list however, for the simple reason that physicians are independent professionals, yet their fees are reimbursed by the provincial healthcare insurance program.  Transparency aims at shedding light upon this paradox.

Eric Hoskins, Ontario Health Minister, recently revealed several Ontario physicians billed over 1 million dollars to OHIP last year, with the top biller at over 6 million dollars.  No names were mentioned, but the initiative to include physicians on the Sunshine list aims at shedding light on the disparities in physician spending.

Ontario physicians argue that there can be no transparency without context.  The cost of overheads and equipment must be specified so that the public can understand the amounts presented to them.

Despite concerns from physicians and opposition from the Ontario medical Association, the Ontario privacy commission has deemed that it is in the best interest of the public to disclose the names, specialties and OHIP earnings for the top 100 billing physicians.  The decision to include billing information for all physicians is ongoing.

There is no simple solution in sight.  We are beginning to see a rise in transparency with the voluntary disclosure of the amounts related to the relationships between the pharmaceutical industry and healthcare professionals in 2017, but the decision to include doctors pay on the Sunshine list remains a heated issue of debate between physicians and the government of Ontario.